GI neoplasms part 2: esophageal, gastric and biliary-mcgowan Flashcards
who is more likely to get esophageal cancer
Men>Women (4:1) - new cases and deaths
what is included in esophageal cancer
gastroesophageal junction (GEJ) and 5cm into the stomach
what is the most common esophageal cancer
adenocarcinoma = most secondary to Barretts
where in the world in SCC the more prevalent esophageal cancer
asia and sub-saharan africa
what is the later findings of esophageal cancers (presentation)
dysphagia (progressive over weeks to months)
weight loss
+/- odynophagia, heart burn, dyspepsia, bleeding, coughing, pneumonia, chest/mediastinal/back pain, hoarseness, lymphadenopathy
what is the test of choice for esophageal cancer
EDG with biopsy - establishes diagnosis
what tests are completed after diagnosis of esophageal cancer is confirmed
CBC to check for anemia
LFTs to check AST, ALT and alk phos
CT of check, abdomen, pelvis - look for regional spread
PET CT for distal spread
Endoscopic US - assess depth of tumor and nodes
+/- FNA of any possibly involved nodes
what is the treatment for localized esophageal cancer
endoscopic resection or esophagectomy
what is the treatment of localized esophageal cancer with lymph nodes involved
chemo and/or radiation, then esophagectomy + lymphnodeectomy
what is the treatment for distant spread esophageal cancer
palliative tx with chemo and or radiation
esophageal stending
local brachytherapy
jujunostomy or gastrostomy tube for nutrition
what are the prevention methods for esophageal ccancer
no routine screening
monitor/follow up for Barretts esophagus
encourage lifestyle modifications
NSAIDs may be protective
Anti-acid medications may be protective
what are risk factors for gastric cancer
H/pylori infection/gastritis strongest overall risk factor
pernicious anemia, hx partial gastric resection, smoking, high nitrate/salt diets, low vitamin C diet, hereditary tumor syndromes
what is the most common type of gastric cancer
adenocarcinoma
proximal - secondary to metaplasia
distal - secondary to H. pylori infection
what is intestival gastric cancer
more common
metaplasia of glandular structures
H. pyloria - atrophic gastritis - metaplasia - dysplasia - CA
what is diffuse gastric cancer
poorly differentiated, less glandular
less related to h.pylori, mor ehereditary